多瑞吉在癌症患者术后镇痛中的应用与临床观察

The clinical observation and using of Durogesic for the patient of cancer in postoperative analgesia

目的 研究应用多瑞吉(芬太尼透皮贴剂TDF)在癌症患者实施术后镇痛中的临床效果。方法 选择乳腺癌、子宫癌、卵巢癌、大肠癌患者90例,ASAI～Ⅱ级,随机分为A、B、C三组。A组患者于术前12h在胸前皮肤平整处贴上含有2 .5mg芬太尼(2 5 μg/h)的多瑞吉贴剂;B、C两组患者则在入室后贴用。B组除乳腺癌患者外,术毕硬膜外单次注射吗啡2mg +0 .2 %罗哌卡因5ml镇痛。按视觉模拟评分法(VAS ,0～10分)于术后6、12、2 4h行疼痛程度评分。结果 A、B两组患者术后镇痛效果均达VAS 0～3分。C组患者在术后12h内镇痛评分明显高于A、B两组患者。A组患者术前均有不同程度的头晕、头迷、烦躁、嗜睡等不适症状。乳腺癌患者头晕、恶心、呕吐等副作用的发生率明显高于子宫癌、卵巢癌、大肠癌患者。所有患者贴用多瑞吉期间未观察到呼吸抑制。结论 多瑞吉经皮给药系统应用于乳腺癌患者,术后镇痛效果满意;而用于子宫癌、卵巢癌、大肠癌患者,则宜与硬膜外单次注药的术后镇痛(PCEA)配合实施效果更佳。用药时机以入室后在胸前贴用为好,不宜术前应用。

Objective To study the cli ni cal observation of durogesic used for postoperative analgesia of patients of can cer. Methods 90 patients of ASA Ⅰ～Ⅱ of cancer under go ing selection operation under epidural anesthesia were randomly divided into thr ee groups: 25μg/h durogesic patch used at 12 hours ahead of operation (group A, n=10), 25μg/h durogesic patch used just before operation (group B and group C, n=10). All the patch were set on the infraclavicular skin. VAS score were measur ed at 6?12?24 hours after operation. Results The VAS s core all were 0～3 in group A and group B. Dizziness, dysphoria were found in gr oup A. Conclusion Durogesic is safe and efficient for pos toperative analgesia. The better choice is using it just after the patient's ent ering operation room. We recommend it be used associated with PCEA.